No Left Turns

Is Our Health Care System Killing Us?

Advocates of reform often cite average life expectancy in the United States, which is lower than in a number of other industrialized countries, as evidence that the nation’s health care system requires an overhaul. However, a recent study by the National Bureau of Economic Research suggests that the system isn’t the problem. Specifically, the authors consider mortality rates among those suffering from breast cancer and prostate cancer--diseases for which "behavioral factors do not play a dominant role"--and find that the United States does quite well in comparison with other OECD countries. In short, it’s obesity and smoking that are killing Americans, not the availability of quality health care.

If it's our behavior, as individuals, that is the root of the problem, and the cause of sickness and death, than why don't we let the government regulate our behavior? Clearly, sickness and death is a form of oppression; oppression is bad and the opposite of oppression is freedom, which is good, and freedom is what this country is founded upon. We must allow a reinvigorated freedom to prevail in America. This new liberty is the liberty to live free from all medical want in order to pursue happiness because if a person is in ill health he cannot be happy. It is, after all, the duty of the government to secure "life and liberty" for each citizen in order that they can equally partake in "the pursuit of happiness". Until the government relieves us from our oppressive selves, which is apparently the root cause of medical problems, we are not truly free, and the government is not fulfilling its ends. Government run health care is a political and moral necessity for America

I am not sure that H. Croly is being sarcastic. We could use some tort reform, we could also look at intellectual law and see what can be done about making generics available more quickly. Because Canada caps the price that certain drugs can be sold for they ensure that they get the tail and middle sections of the curve that have the most value, because the drugs have already been vetted and tried in the United States. To use a business example from outside the sector, Levi jeans sells jeans at Wal-Mart(for about $22 a pair), but they also sell at Macy's and JC penny's and Sears, in each case with slightly different displays/selection and "quality". Levi's also has Levi jeans stores and they also have some non-affiliated jean specialty shops that sell the $500 and up vintage denim. American pharmaceutical companies sell and give away to the CDC and foreign countries a large portion of drugs quickly developed for outbreaks like the swine flu. But what is essentially happening because we are talking about chemical compounds that are "homogenious" is that price discrimination occurs without a product discrimination. The Europeans (in particular some french pharmaceutical companies) do end up subsidizing healthcare on the drug side for the rest of the world. Still healthcare overall is better in Europe and the United States, but just as some critics of Wal-Mart alledge that it puts tremendous pressure and yields pricing power on its suppliers, even more so and directly via price controls do countries like Canada do the same. The United States thus becomes the Macy's and designer jean capital of the world in terms of pharmaceutical pricing. On some level pharmaceutical companies in Europe and the United States do end up subsidizing the rest of the world. It is also probably the case that subsidizing and helping out the CDC is a good thing over all, americans might be slightly worse off because they pay for it, but even if there is no moral argument requireing such altruism, a bad outbreak in mexico or even the republic of Congo is bad for the world overall, and what is bad for the world is bad for the United States no less than what is good for GM is good for the United States.

What some in government are trying to do is to essentially put price controls upon the pharmaceutical companies, whereby we move from being designer jean shops past Macy's to JC Penny to Sears only a step or two above Wal-Mart. If for example we set our price targets slightly above the Canadians pharmaceutical companies would continue to sell and deliver to us, it would mean howhever considerably less R&D and costly drug development, but we could also relax drug trials and regulation essentially also reducing our vetting costs. We would then have slightly less innovation, and somewhat less security(which is in some sense also what we are paying for with our current tort system.) but drastically lower prices.

Of course pharmaceutical companies for the most part also use profits from homerun drugs to subsidize lines of research in rarer diseases, and we don't know when a breakthought in a seemingly unrelated area will lead to insights usefull in another.

If we combined tort reform, price controls, and limited the time horizon on intellectual property rights of drugs speeding them towards generics, we might kill(reduce) R&D and hurt the world as a whole. We could also ease regulations at the FDA and clinical trials, this would probably give us cheaper prices on the drugs we already have, and reduce the barriers to entry on vettedness of new drug developements. This would really mean less money spent subsidizing immediately unprofitable avenues. This would replace much more expensive newer drugs, with much cheaper maverick drugs aspiring to become generics. In fact the generic as a whole might become preferable as a drug that has already survived to the point that others want to duplicate it.

In my opinion the issue is less one of quality than simply an issue of price. Dr. Mosier links to a good article and that is why I would also add a hefty 2 cent per ounce soda tax and increase the tax on tobacco, and since both taxes would be regressive we would be taking small steps towards a flater tax and flater stomachs.

Also to the extent that Brutus is right about the the ect, ect, as I agree with him about the corn syrup(sugar) it isn't unreasonable to force producers to internalize these externalities.

I think I disagree with Brutus about Flouride as this certainly helps fight the effects of corn syrup.

But to some extent as a consumer with limited information, and accumulated habits it isn't unreasonable for the government or better yet insurance companies to advise and provide price discrimination to consumers who take on less risk.

The best insurance program would be a co-opt large enough to know the behaviors of all its employees, which is why some of the redundancy folks talk about as an inefficiency when it comes to companies that do in house insurance rings false.

The United States Armed forces is seriouly considering extending the trainning school no tobacco policy, while this will see difficulties, it is not as if the army doesn't already pay close attention to what folks eat, how they live , how they dress and overall fitness levels.

In fact to go even further I might suggest that John Kerry far being a hippie rebel against Vietnam, is in fact someone who wants discipline and regulation. You can't smoke pot and or be involved with opiates and keep an effective fighting team.

It also seems to me that employers by extending themselves further into health care make the behaviors of the employees necessarily material.

I don't see how a national health care plan could get around to insuring those who demand freedom of behavior in regards the risks they take. In this sense just as there is a NAIRU for unemployment a similar level exists for insurance purposes, and this is exactly what Warren Buffet suggests...Increasing revenue is not by itself a good measure of the health of an insurance company, in a price war a smart insurance company might not add any customers, the same problem exists in regards credit and Fannie Mae, giving out loans is highly profitable so long as your default rate stays low. Smart regional banks who were wise with money did well, some smart insurance companies and co-opts with a certain moral core(the Mormons for example) do an outstanding job of keeping down costs(overcharging).

Universal Health Care joins Full employment and easy credit as things which are desireable but have moral duties attached to them. Measures like NAIRU for employment point to the truth that these duties exist, and that behaviors and actions have consequences, albeit they are just statistical measures of some fairly constant levels of bad/unproductive behavior.

The problem with tort reform is that if do that, then it will start figuring into actuary tables with the giant pharma companies. If they can only get sued for 250k per person mabye the unsafe drug suddenly becomes cost effective. Capping what doctors do is probably more cost effective but there are many extreme cases where millions probably are warranted. Some sanity would go a long a way in this realm rather than draconian statutes.

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